Your Password to Privacy: Standard Authorization Form

Your Password to Privacy: Standard Authorization Form

Your Password to Privacy: Standard Authorization Form

Recently, a family member of mine had surgery.  I called the hospital to see how everything was and I was asked for the patient’s password.  Password? I said my name.  No, not it.  The patient’s name?  Nope.  The hospital?  Negative. Three strikes and I was out of luck. My reaction was, “what just happened?” The nurse explained that it was all about guarding the patient’s protected health information (PHI). He said they only give patient PHI to those with the password, chosen by the patient.

Blue Cross and Blue Shield of Illinois (BCBSIL) protects its members in this same way.  All members can keep their PHI safe by using a Standard Authorization Form.

Your Standard Authorization Form
A Standard Authorization Form lets you decide how BCBSIL can share your PHI.  You can list all the names you’d like and set a timeline so we know when this permission ends.  You can also choose what information is released.

For example, if a family member is helping with your care, you can add their names to your form. Others could be:

  • Your spouse
  • A friend
  • A lawyer
  • Your parents

You can change – or cancel – your form at any time. If you don’t want your information disclosed to anyone, there’s no need to use a Standard Authorization Form.

Completing Your Standard Authorization Form
The form has five pages. After reading all the instructions, the last two pages ask you to:  

Section I - Enter your information
Section II - List who can get your health information
Section III - Confirm what’s shared
Section IV - Set a timeline
Section V - Sign form to validate

We suggest keeping a copy of your final form before mailing.  You can always visit Blue Access for MembersSM (BAM)  to print new copies of the Standard Authorization Form.

Do you have questions about this or any other part of your health insurance plan? Ask us below!

Originally published January 20, 2015; Revised 2018